Introduction

Rheumatoid arthritis is the most common form of inflammatory arthritis, affecting about two to three million Americans. Rheumatoid arthritis is a symmetric disease, meaning that it will usually involve the same joints on both sides of the body.

Approximately 90 percent of people with rheumatoid arthritis will have arthritis of the foot or ankle. The pain may prevent sufferers from walking and can even lead to deformity if left untreated. The human foot is prone to developing rheumatoid arthritis because it contains such a large number of joints and is put under a lot of pressure.  The ankle, which is a hinge joint linking the shin bone to the fibula, is a little less likely to develop rheumatoid arthritis but is also put under immense pressure daily.

About 8 out of 10 Americans will suffer foot or ankle problems at one point in their lives. On average, people will walk about 100,000 miles during their lifetime. That distance is equivalent to four trips around the world. Studies have found that women walk about 10 miles a day while men walk only seven. In addition, the average person's foot absorbs 500 pounds of pressure with each step. In one day, that total comes to about 5 million pounds. Perhaps it comes as no surprise that the foot and ankle are at risk for developing rheumatoid arthritis.

Causes of Rheumatoid Foot and Ankle

The exact cause of rheumatoid arthritis is unknown. However, there are several views about what could cause it. A sudden and traumatic injury, such as an ankle sprain, may cause the injured joint to become arthritic in the future.

Some experts think rheumatoid arthritis is an autoimmune disease, meaning that the body tissue is the victim of an immune response against itself. The body creates antibodies that actually attack the joints causing the swelling and redness. Excess fluid will be produced in the joint space.

Many doctors believe that a virus or bacteria may prompt rheumatoid arthritis to develop in those people who have a genetic predisposition to it. Seven out of ten people who have rheumatoid arthritis have an inherited chemical marker on their cells leading doctors to believe that there is a correlation.

Symptoms may develop as the result of many other factors as well, including:

• the use of prescription and/or illegal drugs
• contact with certain chemicals
• bowel disorders such as ileitis and colitis
• obesity, which often aggravates arthritic conditions
• severe stress

Symptoms of Rheumatoid Foot and Ankle

If you suffer from rheumatoid foot and ankle, you will have problems walking. You may experience pronation of the foot, walking on the sides of your feet. If left untreated, you may end up unable to walk at all. In addition to the deformities of the foot, you may feel tired and weak and have a poor appetite. The common symptoms of rheumatoid arthritis are pain, swelling and stiffness in one or more joints.

Other foot problems usually accompany rheumatoid foot and ankle such as bunions, corns and ulcers. Pain in the sole or ball of the foot is also common. The ankle is usually the last joint in the foot to be affected with rheumatoid arthritis but could become painful.

Rheumatoid arthritis symptoms tend to come and go and can flare up in times of stress. The pain may be constant, similar to a headache. Your joints may feel hot and fever could set in.

To diagnose your disease, your doctor will ask you about your medical history and perform a physical examination. He or she will ask you about your activities and occupation as they may have an impact on your diagnosis. Your doctor will probably consider the possibility of associated injuries or conditions, such as rheumatoid arthritis in the joints of the knee and hips. If your doctor orders an x-ray taken of the joints in your foot, he or she may see tissue swelling and joint destruction.  

Treatment of Rheumatoid Foot and Ankle

While there isn't a cure for rheumatoid foot and ankle, treatment can relieve pain and slow down the damage to the joints while at the same time can improve your ability to walk.

Drug therapy may be necessary to help control the disease. Nonsteroidal anti-inflammatories (NSAIDs), such as aspirin and ibuprofen, may be used. Cortisone shots can also help ease pain and swelling and help slow the damage to the joints. There are also a group of drugs know as disease modifying anti-rheumatic drugs (DMARDs) which are sometimes prescribed. Be sure to discuss with your doctor all the medications you are taking before starting drug therapy for rheumatoid foot and ankle.

Assistive devices, such as orthotics (shoe supports like pads and insoles) and walking canes, may also help.

If conservative treatment methods fail, surgery may be necessary. Ankle replacement surgery (arthroplasty) may improve an ankle joint that has been damaged by injury or some type of arthritis. Recovery and rehabilitation from the surgery may take as long as six weeks.

Your doctor can help you sort through all the treatments of rheumatoid arthritis to plan the best course of treatment for your specific condition.